Non‐Smoker Discount Affidavit


All covered employees must complete and submit this affidavit within 60 days following enrollment in our workplace health coverage.


To continue receiving health insurance coverage at a discounted rate, all covered employees must certify that either: (1) they do not smoke and have not used any tobacco products within the last 12 consecutive months, or (2) they have completed an approved smoking cessation program. Cigna offers a smoking cessation program at no cost to its members. By completing this program or another approved smoking cessation program, you will qualify for the discount.

Employees who cannot truthfully make this certification within 60 days of enrollment will be required to pay an additional $23.00 per pay, which is approximately $50.00 per month

Important: Cigna’s smoking cessation program may take two-to-four weeks to complete. Program must be taken during non-working hours and completed within 60 days following enrollment before submitting this affidavit to continue receiving the non-smoker’s discount. 

Click here to learn how to register for Cigna’s approved smoking cessation program.

Please contact Human Resources with any questions or concerns you have regarding this affidavit.

Please submit one of the following selections.